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( Young Kul Jung ),( Tae Hyung Kim ),( Jong Jin Hyun ),( Seung Young Kim ),( Sung Woo Jung ),( Ja Seol Koo ),( Hyung Joon Yim ),( Sang Woo Lee ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1
Aims: Primary biliary cholangitis is an autoimmune liver disease that is common among middle-aged women, and the small bile ducts are lost by non-purulent cholecystitis and can gradually progress to cholestasis, liver fibrosis, and cirrhosis. For a type of autoimmune disease, Anti Mitochondrial Antibody(AMA) is found in about 90-95% of patients. However, the incidence is relatively low, and furthermore, studies on the evaluation of treatment response in Korea are very rare. This study was designed to analyze the patterns and treatment trends of patients diagnosed with PBC in a single institution. Methods: From 2010 to 2020, the medical records of Korea Univ. Ansan Hospital were investigated and 95 patients suspected or diagnosed as PBC have been checked to analyze 92 patients, excluding those with missing records or insufficient diagnosis. Among these patients, the response rate of UDCA treatment was evaluated in 67 patients who were followed up for more than one year. For diagnosis and evaluation of treatment response refer to 2018 AASLD PBC Practice Guidance. The treatment response was based on the normalization of ALP at the first year of treatment. In the serum test, the Anti Mitochondrial Antibody (AMA) test was performed using the Fluorescent antibody test. Results: A total of 95 patients had an mean age of 56 years, of which 87 were female and 8 were male, with a sex ratio of 10.9: 1. At the time of diagnosis, 33 patients (34.7%) had cirrhosis and 48 patients (50.5%) had auto-immune related comorbidities. The most common was thyroid disease (13 patients, hypothyroidism), and Sicca syndrome, Raynaud disease, Behcet’s disease, SLE, and so on. Symptoms usually complained of itching and pruritis. but most were asymptomatic. In serologic examination, 92 AMA positive PBC (96.8%), and the other 3 showed negative findings in gp210 or sp100, but the diagnosis was progressed by clinical pathological findings. In further studies with stored samples, gp210 and sp100 were positive in 33% and 15%, respectively. In addition, PBC / AIH overlap was diagnosed in 13 patients (13.7%) on serological histological examination. Eight patients (11.9%) showed insufficient treatment response in 67 patients following follow-up of UDCA for more than one year, especially positive (33%) in gp210 and Ro-52 antibodies and with autoimmune hepatitis( AIH). More than half the patients with insufficient treatment response showed PBC / AIH overlap feature. Conclusions: PBC patients are often accompanied by systemic autoimmune disease at the time of diagnosis, and some patients are accompanied by AIH when diagnosed, and they often do not reach a sufficient response within 1 year of treatment with UDCA. In addition, antibody diagnostics other than AMA may be helpful in predicting treatment response during diagnosis of these patients.
( Young Kul Jung ),( Dong-won Lee ),( Ja Seol Koo ),( Jung Wan Choe ),( Sang Jun Suh ),( Seung Young Kim ),( Jong Jin Hyun ),( Sung Woo Jung ),( Hyung Joon Yim ),( Sang Woo Lee ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1
Aims: Hepatitis delta virus (HDV) and hepatitis B virus (HBV) coinfection is associated with more severe liver disease than HBV alone. More knowledge on the epidemiology and clinical impact of HDV-infected individuals is needed in Korea. Despite the development of new antiviral agents of HDV these days, it is not well known characteristics and prevelance of hepatitis delta virus infection in patients with chronic hepatitis B in Korea. Methods: Total 1263 HBV infected patients visiting liver clinic at Korea University Ansan Hospital from January to December 2014 were screened for anti-HDV antibodies using ELISA assays. Comfirmed positive samples were further tested for HDV RNA using a commercial RT-PCR assay. Clinical characteristics and biological data from patients were researched and compared based on anti-HDV antibodies and HCV RNA results Results: Most patients (n=814, 65%) were men and mean age was 49 years old. Anti-HDV anti-bodies were detected in 11 individuals (0.87%), 2 of whom were HDV RNA positive. Anti-HDV antibody positive patients showed similar clinical features, these had liver cirrhosis (45.5% vs. 33.8%, P=0.524) and HCC (18.2% vs. 12.9%, P=0.643) compared with HDV negative. However, all of 2 patients with HDV-RNA positivity showed significant cirrhosis. Conclusions: HDV infection is rare in patients with chronic hepatitis B in Korea, but is related with liver cirrhosis in HDV RNA positive patients. However, HDV co-infection may not have a clinical importance.
( Young Kul Jung ),( Tae Hyung Kim ),( Han Ah Lee ),( Sun Young Yim ),( Young-sun Lee ),( Ji Hoon Kim ),( Yeon Seok Seo ),( Hyung Joon Yim ),( Jong Eun Yeon ),( Kwan Soo Byun ),( Soon Ho Um ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1
Aims: Sofosbuvir (SOF) and ribavirin (RBV) for 12 or 16 weeks is recommended for treatment of patients with HCV genotype (GT) 2 infected patients in KASL guideline based on clinical trials. Whether sustained virological response of HCV infection has any beneficial effect on improvement of liver fibrosis associated with chronic HCV infection remains unclear. We investigated to assess the effects on liver fibrosis of at least 2 years through follow-up liver biopsy and fibroelastography after treatment with sofosbuvir plus ribavirin for HCV G2 infection. Methods: Three tertiary center, prospective observational cohort study evaluates clinical practice data (Korea university Anam, Guro, and Ansan) between January 2015 and December 2019. Clinical data were centrally collected from medical records. The efficacy outcome was sustained virological response 12 weeks after therapy (SVR12). The degree of liver fibrosis was evaluated by APRI score, FIB-4, fibroelestography and paired liver tissue biopsy. Results: 146 patients were visited and 131 patients were treated SOF plus RBV during 12 weeks (n=122) or 16 weeks (n=9). Overall, EVR, ETR, and SVR12 by ITT analysis were 90.0%, 96.2% and 87%. In addition, EVR, ETR, and SVR12 by PP analysis 97.5%, 99.2% and 96.3%, respectively. In subgroup analysis, SVR12 in patients with treatment-naïve and treatment-experience were 97.2% or 94.7%, respectively. SVR12 in patients with and without cirrhosis were 94.4% and 97.4%, respectively. Finally 106 patients showed sutained virological response and follow up 2 year after treatment. The mean APRI score was 0.57 before treatment, but improved to 0.27 at 2 year after treatment (P=0.004). The mean FIB-4 score was 2.15 before treatment, but improved to 1.53 at 2 year after treatment (P=0.004). The mean fibroelastography value was 10.81 kPa before treatment, but improved to 4.75 kPa at 2 year after treatment (P=0.008). Follow-up liver tissue biopsies were done in 8 patients and fibrosis was evaluated by Metavir score (F0-4). Almost all patient except one showed improvement of cirrhosis (≥1 unit decrease in Metavir score, P=0.031). Conclusions: SOF and RBV was safe and effective for treatment of patients with HCV GT2 infection. In patients with sustained virological response 2 year after SOF and RBV, the improvement or regression of liver fibrosis could be observed in biochemical and histological aspect.
( Young Kul Jung ),( Kwang Seok Kim ),( Ji Kyoung Lee ),( Sang Yoon Chung ),( Chang Bum Bae ),( Joo Hee Park ),( Sang Jun Suh ),( Seung Young Kim ),( Jong Jin Hyun ),( Ja Seoul Koo ),( Hyung Joon Yim 대한내과학회 2014 대한내과학회 추계학술발표논문집 Vol.2014 No.1
Background: The aim of this study is to compared with transient elastography and other invasive fi brosis marker, and to investigate several factors infl uencing the liver stiffness measurement (LSM) in chronic hepatitis B patients. Methods: Two hundred twenty eight patients with chronic hepatitis B who underwent liver biopsy and TE in the same time were recruited from January 2008 to December2013. Results: 159 (69.7%) of them were Male, and mean age was 41.9 years old. Mean of AST and ALT were 114.9 IU/L and 165.1 IU/L, respectively. Platelet count was 1.75 x 103 cell/uL.. 102 (44.7%) patients had HBeAg positivity. In liver Biopsy, 39 patients (17.1%) had F0-1, 57 (25.0%) had F2, 76 (33.3%) had F3, and 56 (24.6%) had F4, respectively. In view of the signifi cant fi brosis (F4), TE showed signifi cantly good estimate of liver fi brosis, and corresponding area under the ROC curves of LSM was 0.733 that showed slightly good estimate value compared with APRI (0.468) and fiB-4 (0.641). Among the lower ALT patients (ALT under 100 IU/L) corresponding area under the ROC curves of LSM was 0.804, and among HBeAg negative patients corresponding area under the ROC curves of LSM was 0.755. The cutoff LSM values for >F2, >F3, and F4 were 6.9, 8.5, and 10.1 kPa, respectively, whereas they were 6.2, 7.5, and 9.6 kPa, respectively, in those with ALT <X2 UNL. Conclusions: TE has good estimate performance for liver stiffness and fi brosis compared with AFRI and fiB-4 in chronic hepatitis B patients. However, ALT and HBeAg could influence liver stiffness. So, different cutoff LSM values may be applied in chronic hepatitis B patients.
( Young Kul Jung ),( Jong Eun Yeon ),( Woo Sik Han ),( Ji Hoon Kim ),( Jeong Han Kim ),( Jong Jae Park ),( Jae Seon Kim ),( Young Tae Bak ),( Wang Don Yoo ),( Sun Pyo Hong ),( Soo Ok Kim ),( So Young 대한소화기기능성질환·운동학회 2010 Gut and Liver Vol.4 No.2
Background/Aims: The aim of our study was to define the potential role of virologic response at 12 months of treatment (VR12) in predicting subsequent virologic and clinical outcomes in adefovir (ADV)-treated lamivudine-resistant chronic hepatitis B. Methods: Two hundred and four patients with lamivudine-resistant chronic hepatitis B virus (HBV) treated with ADV monotherapy were included. Serum HBV DNA was quantified by real-time polymerase chain reactions. VR12 was defined as a HBV DNA level of less than 4 log10 copies/mL after 12 months of ADV treatment. Results: VR12 was observed in 110 of the 204 patients (54%). The mean HBV DNA reductions from baseline after 12 months of ADV treatment were 3.8 and 1.9 log10 copies/mL in patients with and without VR12, respectively (p<0.001). The hepatitis B e antigen (HBeAg) seroconversion rates in patients with and without VR12 were 32% and 14% at 12 months treatment, respectively (p=0.018), and 40% and 27% at 24 months of treatment (p=0.032). The genotypic mutation rates to ADV in patients with and without VR12 were 0% and 6% at 12 months of treatment, respectively (p=0.033), and 21% and 42% at 24 months (p=0.012). The rates of viral breakthrough in patients with and without VR12 were 0% and 7% at 12 months of treatment, respectively (p=0.072), and 9% and 25% at 24 months (p=0.006). Conclusions: Patients without VR12 may need to switch to or add on other potent antiviral drugs in their medical regimens. (Gut Liver 2010;4:212-218)
Clinical Aspect of Coronavirus Disease 2019 (COVID-19) on HBV Infected Patient
( Young Kul Jung ),( Gi Hyeon Seo ),( Tae Hyung Kim ),( Sun Young Yim ),( Young-sun Lee ),( Ji Hoon Kim ),( Yeon Seok Seo ),( Hyung Joon Yim ),( Jong Eun Yeon ),( Kwan Soo Byun ),( Soon Ho Um ) 대한간학회 2021 춘·추계 학술대회 (KASL) Vol.2021 No.1